Provider Demographics
NPI:1972142503
Name:HOLDEN, JAMES CEDRICK III (PA-S)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:CEDRICK
Last Name:HOLDEN
Suffix:III
Gender:M
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 1ST ST NW
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-2932
Mailing Address - Country:US
Mailing Address - Phone:641-428-7847
Mailing Address - Fax:
Practice Address - Street 1:1010 4TH ST SW
Practice Address - Street 2:SUITE 105
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-2857
Practice Address - Country:US
Practice Address - Phone:641-428-7847
Practice Address - Fax:614-428-7999
Is Sole Proprietor?:No
Enumeration Date:2019-12-30
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IA108393363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program